Para dar suporte à implementação do Programa Nacional de Controle e Erradicação da Brucelose e Tuberculose no Estado do Mato Grosso do Sul, foi realizado um estudo para caracterizar a situação epidemiológica da brucelose bovina. Considerando as características regionais da produção pecuária, foram definidos três estratos a serem estudados no Estado: Pantanal corte, Planalto corte e Planalto leite, esse último subdividido em Bolsão, Campo Grande e Dourados . Em cada estrato foram amostradas aleatoriamente propriedades, e dentro dessas foi escolhido, também de forma aleatória, um número pré-estabelecido de animais, dos quais foi obtida uma amostra de sangue. No total foram amostrados 14.849 animais, provenientes de 1.004 propriedades. Em cada propriedade amostrada foi aplicado um questionário epidemiológico indagando sobre suas características e também sobre a observação de transtornos reprodutivos que poderiam estar associados à infecção brucélica. O teste utilizado foi o do Antígeno Acidificado Tamponado. O rebanho foi considerado positivo se pelo menos um animal fosse reagente à prova sorológica. Para o Estado, a prevalência de focos foi de 41,5% [36,5% - 44,7%]. As prevalências de focos e animais nos estratos foram respectivamente de: 59,0% [52,8% - 64,9%] e 12,6% [9,1% - 17,2%] para o estrato Pantanal corte, 40,6% [35,8% - 45,5%] e 4,5% [2,1% - 9,0%] para o Planalto corte. No estrato Planalto leite, a prevalência de focos foi de 33,1% [28,4% - 38,1%]. Os fatores associados à condição de foco foram: ter ≥ 500 vacas (OR = 2,46 [1,81 - 3,34]), a ocorrência de bezerros fracos (OR = 1,20 [0,87 - 1,65]) e a inseminação artificial (OR = 0,71 [0,50 - 1,01]). / To support the planning and implementation of the National Program for the Control and Eradication of Brucellosis and Tuberculosis in the State of Mato Grosso do Sul, a study to characterize the epidemiological status of bovine brucellosis was carried out. The State was divided in three regions. Herds were randomly sampled in each region, and a pre-established number of animals were sampled in each of these herds. A total of 14.849 serum samples from 1.004 herds were collected. In each herd it was applied an epidemiological questionnaire focused on herd traits as well as clinical signs that could be associated with the brucellosis infection. The serum samples were tested for antibodies against Brucella spp. by the Rose-Bengal Test (RBT). The herd was considered positive if at least one animal tested positive. The prevalence of infected herds at the State level were 41.5% [36.5% - 44.7%]. The prevalence of infected herds at the Regional level were respectively: 40.6% [35.8% - 45.5%] for the Beef Planalto region, 59.0% [52.8% - 64.9%] for the Beef Pantanal region and 33.1% [28.4% - 38.1%] for the Dairy Planalto region. The factors associated with the presence of the infection were: herd size bigger than 500 cows (OR = 2.46 [1.81 - 3.34]), occurrence of weak calf (OR = 1.20 [0.87 - 1.65]) and use of artificial insemination (OR = 0.71 [0.50 - 1.01]).

No description available.

Background: Diabetes is the seventh leading cause of death in the United States. More and more people have suffered from diabetes and its serious complications including heart disease, blindness, etc. The U.S. Department of Veterans Affairs (VA) reported that nearly 25% of veterans, enrolled in the Veterans Health Administration (VHA), have diabetes, which is much higher than the general population. Objective: This study aimed to estimate the prevalence of diabetes in the U.S. veterans using the up-to-date National Health and Nutrition Examination Survey (NHANES) data since VHA has a relatively low coverage (less than 30% of veterans each year were enrolled). Methods: Five biennial cross sectional surveys (NHANES) between 2005-2014 were used in this study. Total 2,940 veterans were included to estimate the prevalence of diabetes. Total diabetes was defined as any participant who had at least one of four conditions: (1) a hemoglobin A1c at least 6.5%, (2) fasting plasma glucose (FPG) at least 126mg/dL, (3) a 2-hour plasma glucose (PG) at least 200mg/dL, (4) diagnosed with diabetes by a doctor or other health professional. Results: The overall prevalence of total diabetes (including diagnosed and undiagnosed diabetes), undiagnosed diabetes and obesity were 20.54%, 3.37% and 40.68%, respectively. The family poverty level and education were significantly associated with the presence of diabetes with p=0.005 and 0.03, respectively. Highest prevalence diabetes and obesity existed in veterans aged 65yrs and over and 45-64yrs, respectively. The overall prevalence trend of diabetes significantly increased from 15.52% (95%CI: 12.36-18.68%) in 2005-2006 to 20.54% (95%CI: 15.92-25.17%) (p=0.04 for trend test) and prevalence significantly increased in male veterans ( p=0.04) and those who did not finish high school education (p=0.04) and who had college education (p=0.03). Conclusion: In 2013-2014, the estimated prevalence of diabetes was 20.54% among U.S. veterans, with higher prevalence among participants who were 65 years old or older, and had low socioeconomics status (including less education and poverty status).

Thesis (MPH.) --University of Limpopo, 2016 / Background: Malaria is one of the important communicable diseases transmitted by Anopheline mosquitos to humans and is endemic in 108 countries around the world. Most malaria epidemics in African highland countries are caused by Plasmodium Falciparum (P Falciparum) and people residing in highlands are said to be having low immunity to malaria and both children and adults are affected by the disease, whereas vivax malaria is common in lowlands African countries. The current study was undertaken with an aim to determine the spatial distribution of malarial cases during the period 2006 to 2015 in Mopani District of Limpopo Province, South Africa. Methods: Quantitative retrospective descriptive methodology was employed to review the malaria distribution in Mopani district. A total of 12 037 malaria cases were identified for the period of the study and the data was kept anonymously by not using the names of the patients. Ethical clearance was received from the Turfloop Research Committee of University of Limpopo in consideration of section 14, 15, 16, and 17 of National Health Act 61 of 2004. The data was exported to excel spreadsheet and cleaned before exported into SPSS 23.0 software which was used for data analysis. Results: The findings revealed that most malaria cases were found in 2006 and again in 2014 and 2015 respectively. Malaria cases were also seen to be seasonal and were very high during January, February, March and April. Malaria cases also hiked during the month of October. The results also show that most malaria cases were reported between the patients aged of 16 to 25 and 26 to 40 years. There were more males than females who were infected by malaria in Mopani district and the sub district which was found to be having high malaria cases is Greater Giyani with more than 50% of the population (51.1%); followed by Ba Phalaborwa (23.1%); then Greater Tzaneen 13.1%. Conclusion: Mopani district has halved its malaria transmission for the comparison years, however the slow reduction in numbers of deaths is still a cause for concern. Key words: Malaria prevalence, spatial distribution, case fatality rate, elimination.

Recently maternal intake of multivitamins has been associated with a reduced risk of orofacial clefts (OFC)in human epidemiologic studies. In the Philippines, vitamin B-6 deficiency was found to be associated with increased risk of OFCs. The birth prevalence of OFCs in the Philippines is among the highest known, but Filipino emigrants in the United States have lower rates, indicating that environmental factors may play an important role in causing OFCs in the Philippines. The prevalence and possible causes of vitamin B-6 deficiency were investigated through dietary and biochemical assessments in case-control study in Negros Occidental, Philippines. Mothers with OFC offspring (cases) were ascertained during a 2-week OFC surgical mission of Operation Smile in 1997, and mothers without OFC offspring (controls) were recruited at randomly selected neighborhood health centers. Sixty-three percent case-mothers and 41 percent control-mothers were vitamin B-6-deficient. Dietary vitamin B-6 intake was low in both cases and controls but lower in cases. Case-mothers consumed 9.4 percent fewer calories than the control-mothers. Rice was the major contribution of total energy, carbohydrate, and protein for both cases and controls. Both cases and controls consumed fruits, seafood, dairy, fats, and oils with similar frequency, but cases consumed grains and grain products, vegetables, meats, beans and bean products, and roots less frequently. The vitamin B-6 activity coefficient, an indicator of vitamin B-6 deficiency, was correlated positively with plasma homocystine and negatively with plasma and red cell folate in cases only. No significant correlations were found between vitamin B-6 status and maternal age, smoking, or drinking, in either cases or controls. Vitamin B-6 deficiency appears to be an important yet complex problem in Negros Occidental because it is widespread and strongly associated with the risk of OFC birth defects. This condition may be a consequence of 1) high polished rice consumption, 2) low vitamin B-6 intake from other food sources, 3) presence of glycosylated vitamin B-6 in plant foods, 4) high vitamin C-induced vitamin B-6 hydroxylation, or 5) a potential zinc deficiency.

Cardiovascular disease (CVD) is a major contributor to chronic diseases. High blood pressure and other modifiable cardiovascular risk factors are on the increase in Nigeria. The purposes of this study were to (a) explore associations among high blood pressure, social economic status, and health status awareness and (b) measure the incidence and prevalence of cardiovascular diseases in 3 states of Nigeria: Lagos, Ekiti, and Ondo. Participants (N = 368) were selected through stratification and randomization. Data were collected in person with the aid of validated questionnaire, which measured socioeconomic status as well as other variables in Lagos, Ado Ekiti, Ijesa-Isu, and Akure. Logistic regression and correlation analyses showed no significant difference in the regional incidence and prevalence of cardiovascular disease (F (4, 362) = 1.23, p = 0.30); and there was no significant relationship between the health status variable and the standard of living variable. Due to the fact that only 3 out of 36 states were sampled, this study is not generalizable and some other cardiovascular diseases modifiable risks factors that were not measured could have reacted differently in analysis. This study's results set precedence by promoting cardiovascular health. When disseminated, the results of this study will help advocate for a change process that curtails cost and decreases the general burden of CVDs in other, similar areas. Recommendations include measuring this incidence and prevalence of CVDs in all 36 states of Nigeria and exploring the interactions between culture, religion, health, and beliefs.

Undernutrition is a global public health challenge. In Somalia, undernutrition is chronic with the situation often graded for emergency response. The purpose of this study was to provide contextual evidence regarding trends of prevalence and predictors of undernutrition in South Central Somalia. Following the UNICEF conceptual framework of determinants of undernutrition, the study examined which individual, household, and society factors were associated with undernutrition. Using secondary data from cross-sectional nutritional surveys implemented by the Somalia Food Security and Nutrition Analysis Unit from 2007 to 2012, a sample of 75,756 and 60,856 children aged 6-59 months was used in analyzing trends in prevalence and predictors of undernutrition respectively. Linear regression was used to examine trends, while Generalized Estimation Equations were used to determine predictors of undernutrition. Results of this study showed that from 2007 to 2012, there was a declining trend in the prevalence of stunting (R2 = 0.73; p < 0.05) while there was no significant trend in terms of underweight and wasting. When individual, household, and society factors were considered simultaneously, diarrhea, child gender, diet diversity, and minimum meal frequency were significant predictors of underweight; child gender and meal frequency significantly predicted stunting while wasting was significantly predicted by diarrhea, malaria, and diet diversity. Geographical region and livelihood system were significant predictors of undernutrition. The study findings provide evidence to inform nutrition policy and programs that could result in eliminating disparities in child nutrition and reducing undernutrition, ultimately improving survival and development of children in Somalia.

Foi realizado um estudo seccional sobre a situação epidemiológica da brucelose bovina no Estado de Tocantins com o objetivo de avaliar a eficácia do programa de vacinação implementado. O Estado foi dividido em cinco regiões e em cada uma delas foi aleatoriamente amostrado um número pré-estabelecido de propriedades. Dentro de cada propriedade, fêmeas com idade igual ou superior a 24 meses foram aleatoriamente selecionadas e submetidas à sorologia em série para o diagnóstico da brucelose (AAT e 2-Mercaptoetanol). Ao todo foram examinados 6.846 animais oriundos de 756 propriedades. A prevalência de focos no estado foi de 6,42% [4,76 -8,62] e a de animais 2,21% [1,05 - 4,01]. A prevalência de focos apresentou-se homogeneamente distribuída entre as cinco regiões. Como o estudo realizado em 2003/2003 estimou a prevalência de focos no estado em 21,22% [19,33 - 23,11], conclui-se que o programa de vacinação implementado pelo Tocantins reduziu a prevalência de maneira importante. Assim, recomenda-se que o estado continue seu programa de vacinação, dando grande ênfase para a qualidade dos procedimentos, desde a comercialização do insumo até a inoculação nos animais, pois a imunização ainda é a maneira mais racional de se reduzir a prevalência da brucelose bovina no seu território. Adicionalmente, o estado deve implementar uma forte ação de educação sanitária para que os produtores passem a testar os animais para brucelose antes de introduzi-los nos seus rebanhos, pois verificou-se que a reposição de animais está associada à condição de foco de brucelose bovina. / A cross-sectional study on the situation of bovine brucellosiswas was carried out in the State of Tocantins in order to evaluate the effectiveness of the vaccination program implemented. The state was divided into five regions and in each of them was randomly sampled a pre-established number of farms. Within each property, females aged 24 months or older were randomly selected and submitted to serology for the diagnosis of brucellosis (AAT and 2-ME). A total of 6,846 animals, from 756 farms, were examined. The prevalence of infected herds in the state was 6.42% [4.76 - 8.62] and the prevalence of seropositive animals was 2.21% [1.05 - 4.01]. The prevalence of infected herds was homogeneously distributed among the regions. As the 2003/2003 study estimated the prevalence of infected herds in the state in 21.22% [19.33 - 23.11], it was concluded that the vaccination program implemented by Tocantins significantly reduced prevalence. Thus, it is recommended that the state continue its vaccination program, placing emphasis on the quality of the procedures, from the comercialization of the vaccine to the animal inoculation, since immunization is still the most rational way to reduce the prevalence of brucellosis on its territory. In addition, the state should implement a strong health education program so that farmers start testing animals for brucellosis before introducing them into their herds, as it has been verified that the replacement of animals is the major risk factor for bovine brucellosis in Tocantins.

Objetivo: Determinar la distribución entre el diente en forma de pala y la presencia de lesiones cariosas. Materiales y métodos: El presente estudio es de tipo transversal analítico. Se determinó un tamaño de muestra de 335 niños de 7 a 14 años de edad (1340 incisivos anterosuperiores) utilizando el Software EPIDAT, versión 4.2. Se consideró la clasificación de Hrdlička que se divide en no pala, trazo pala, semi pala y pala. Asimismo, se utilizó como instrumento el Sistema Internacional de Detección y Diagnóstico de Caries II (ICDAS II) para codificar la caries dental desde su estadio más temprano. En una ficha de recolección de datos se registró iniciales del participante, edad, sexo, índice de O’Leary, dieta cariogénica, diente en pala y clasificación de caries. Para el análisis bivariado y determinar la asociación estadística se utilizó la prueba de Chi Cuadrado. Resultados: La prevalencia de incisivos en forma de pala fue de 56.42%. El género con mayor prevalencia fue el masculino con 406(51.64%) dientes que presentaban dicha alteración de forma. Se observó 1229 piezas dentarias que no presentaban caries dental. De las cuales, 583(47.44%) eran forma de no pala y 646(52.56%) forma de pala. Por otro lado, sólo 111 piezas tenían morfología de pala con presencia de caries dental. Se encontró distribución mas no asociación debido a la poca frecuencia de piezas que tienen forma de pala y caries dental. Conclusiones: Se encontró distribución entre los incisivos en forma de pala y caries dental. Esto se debe a la morfología del incisivo en pala, la cual se caracteriza por tener rebordes marginales prominentes, fosa lingual profunda a nivel del cíngulo por la superficie palatina produciéndose un mayor acúmulo de placa. Asimismo, se determinó que el género no es considerado una predisposición. / Objective: To determine the distribution between shovel shaped teeth and the presence of dental caries injuries. Materials and methods: The determined sample was of 335 infants between 7 and 14 years old (1340 incisor at the front of the mouth) using the EPIDAT software 4.2 version. The Hrdlička classification that is divided in no shovel, part shovel, semi shovel and shovel was considered. Likewise, the International Caries Detection and Assessment System II (ICDAS II) was used to code the dental caries since its early stages. The data collection form registries contained the initials of the participant, age, sex, O’ Leary index, cariogenic diet, shovel-shaped teeth and caries classification. The chi-square test was utilized to determine the statistical association and the bi-variate analysis. Results: The remain of the shovel-shaped incisors was 56.42%. the gender that prevailed was the male with 406 (51.64%) teeth that presented such a shape alteration. 1229 incisors of the observed did not present any dental caries. Form this incisor 583 (47.44%) were non-shovel-shaped and 646 (52.56%) were shovel-shaped. On the other hand, just 11 examples had shovel-shaped morphology and the presents of dental caries. Distribution was found but not association due to the infrequency of pieces that have the shape of a shovel and dental caries. Conclusions: A distribution was found between the shovel-shaped incisors and dental caries. This is due to the morphology of the shovel-shaped incisor, which is characterized by having prominent marginal borders, the deep lingual fossa at the level of the palatal surface angle producing a greater accumulation of the plaque. Likewise, it was determined that the gender is not considered a predisposition. / Tesis

A Iniciativa Hospital Amigo da Criança (IHAC) é amplamente adotada nas maternidades brasileiras, porém não considera o contexto complexo e tecnológico das unidades neonatais e as dificuldades de amamentar o prematuro. O objetivo geral é avaliar o impacto da implementação da IHAC para Unidades Neonatais - IHAC-Neo, guiada pelo referencial da Knowledge Translation (KT), na prevalência do aleitamento materno exclusivo (AME) na alta hospitalar, no primeiro mês pós-alta e aos seis meses de vida entre os prematuros, e na adesão às diretrizes da IHAC-Neo. Tratase de estudo de intervenção, controlado, quase-experimental, pré e pós-teste, não equivalente e prospectivo, realizado em dois hospitais Amigos da Criança do Sudeste. A coleta foi realizada em dois momentos nos hospitais (intervenção e controle), com intervalo mínimo de 12 meses, sendo no hospital intervenção antes (M1) e após (M2) a implementação da IHAC-Neo. Foram coletados dados sobre prevalência do AME e condições de saúde dos prematuros por meio de levantamento de prontuários e entrevistas com mães; adesão à IHAC-Neo por meio de entrevistas com profissionais e mães, observação das unidades neonatais e análise documental; e dados qualitativos para monitorar fatores contextuais. A implementação da IHAC-Neo foi guiada pelo modelo Promoting Action on Research Implementation in Health Services da KT e pela estratégia Evidence-Based Practice Identification & Change. Para análise dos dados relativos a prevalência do AME e seus fatores preditores foi utilizado regressão logística com efeito aleatório. Esta tese integra projeto multicêntrico financiado e aprovado por Comitê de Ética em Pesquisa. A prevalência do AME na alta foi significativamente maior no hospital intervenção que no controle (p<0,01), resultante da diferença detectada no M1 (p<0,01) e no M2 (p=0,04), com taxas maiores de AME no hospital intervenção (M1=48,1%; M2=40,8%) do que no controle (M1=3,1%; M2=17,2%). Intragrupo, ao comparar os momentos, não houve diferença significativa no hospital intervenção (p=0,12) nem no controle (p=0,42). No primeiro mês pós-alta, manteve-se a prevalência do AME significativamente maior (p=0,02) no hospital intervenção (M1=46,1%; M2=29,8%) que no controle (M1=6,3%; M2=17,2%), devido diferença no M1 (p=0,02), já que não diferiu no M2 (p=0,41). Intragrupo, ao comparar os momentos, também não apresentaram diferença significativa no hospital intervenção (p=0,12) nem no controle (p=0,40). No sexto mês de vida, o AME somado ao aleitamento materno predominante não diferiu significativamente entre os hospitais intervenção e controle (p=0,27), independentemente do momento da coleta; nem entre os hospitais no M1 (p=0,46) e no M2 (p=0,39), embora o hospital intervenção tenha mantido maiores taxas (M1=14,3%; M2=10,6%) que o controle (M1=3,6%; M2=3,4%). Intragrupo, não houve diferença significativa no hospital intervenção (p=0,96) nem no controle (p=0,90). Na regressão logística ajustada, o único fator preditor do AME foi a duração da internação, apenas na alta hospitalar. Quanto as práticas relacionadas às diretrizes da IHAC-Neo tiveram importante melhora no hospital intervenção, com aumento da adesão global aos Dez Passos de 33% para 67%, aos Três Princípios Norteadores de 43% para 86% e ao Código de 56% para 81%, o que não foi tão pronunciado no controle. Conclui-se que a implementação da IHAC-Neo guiada pela KT aprimorou a prática clínica de promoção, proteção e apoio ao AME, com aumento da adesão à IHAC-Neo, mas não foi suficiente para aumentar o AME em prematuros em curto prazo / The Baby-Friendly Hospital Initiative (BFHI) is widely adopted in Brazilian maternity hospitals, even though the complex and technological context of neonatal wards and the difficulties with breastfeeding premature infants are not considered. The overall objective is to evaluate the impact of implementation of the BFHI for Neonatal Wards (Neo-BFHI) guided by the Knowledge Translation (KT) framework on the prevalence of exclusive breastfeeding (EBF) at hospital discharge, in the first month after discharge, and at six months of life among premature infants, and regarding compliance with Neo-BFHI guidelines. This is an intervention, controlled, quasiexperimental, pre-and post-test, non-equivalent and prospective study conducted in two BabyFriendly hospitals located in Southeastern Brazil. Data collection was performed in two moments at the hospitals (intervention and control) with a minimum interval of 12 months, and at the intervention hospital, collection was before (M1) and after (M2) implementation of the Neo-BFHI. Data on the prevalence of EBF and health conditions of preterm infants were collected from medical charts and interviews with mothers, and regarding compliance with the Neo-BFHI through interviews with professionals and mothers, observation of neonatal wards and documentary analysis. Qualitative data were collected to monitor contextual factors. Implementation of the NeoBFHI was guided by the model of Promoting Action on Research Implementation in Health Services of KT and by the Evidence-Based Practice Identification & Change strategy. Logistic regression with random effect was used for analysis of data on the prevalence of EBF and its predictive factors. This thesis integrates a multicenter project funded and approved by the Research Ethics Committee. The prevalence of EBF at discharge was significantly higher in the intervention hospital than in the control (p<0.01). This was a result from the difference detected in M1 (p<0.01) and in M2 (p=0.04), with higher rates (M1=48.1%; M2=40.8%) than in the control hospital (M1=3.1%; M2=17.2%). When comparing the moments intragroup, there was no significant difference in the intervention hospital (p=0.12) nor in the control (p=0.42). In the first month after discharge, the prevalence of EBF was significantly higher (p=0.02) in the intervention hospital (M1=46.1%; M2=29.8%) than in the control (M1=6.3%; M2=17.2%) because of the difference in M1 (p=0.02), since there was no difference in M2 (p=0.41). When comparing the moments intragroup, there was no significant difference in the intervention hospital (p=0.12) nor in the control (p=0.40). At the sixth month of life, when adding EBF and the predominant breastfeeding, there was no significant difference between the intervention and control hospitals (p=0.27) regardless of the time of collection; neither between hospitals in M1 (p=0.46) and in M2 (p=0.39), although the intervention hospital maintained higher rates (M1=14.3%; M2=10.6%) than the control (M1=3.6%; M2=3.4%). There was no significant difference intragroup in the intervention hospital (p=0.96) nor in the control (p=0.90). In the adjusted logistic regression, the only predictor of EBF was the duration of hospitalization only at hospital discharge. Practices related to Neo-BFHI guidelines improved significantly in the intervention hospital with increase of overall compliance with the Ten Steps from 33% to 67%, to the Three Guiding Principles from 43% to 86% and to the Code from 56% to 81%, which were not as marked in the control hospital. Thus, was reached the conclusion that implementation of KT-guided Neo-BFHI improved the clinical practice of promotion, protection and support to EBF with increased compliance with Neo-BFHI, but it was not sufficient to increase exclusive breastfeeding of preterm infants in the short term